改善养老院手部卫生依从性：一项整群随机对照试验的方案（HANDSOME研究）
Improving Hand Hygiene Compliance in Nursing Homes: Protocol for a Cluster Randomized Controlled Trial (HANDSOME Study).
作者信息
Teesing Gwen R, Erasmus Vicki, Petrignani Mariska, Koopmans Marion P G, de Graaf Miranda, Vos Margreet C, Klaassen Corné H W, Verduijn-Leenman Annette, Schols Jos M G A, Richardus Jan Hendrik, Voeten Helene A C M
机构信息
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, Netherlands.
出版信息
JMIR Res Protoc. 2020 May 1;9(5):e17419. doi: 10.2196/17419.
BACKGROUND
Hand hygiene compliance is considered the most (cost-)effective measure for preventing health care-associated infections. While hand hygiene interventions have frequently been implemented and assessed in hospitals, there is limited knowledge about hand hygiene compliance in other health care settings and which interventions and implementation methods are effective.
OBJECTIVE
This study aims to evaluate the effect of a multimodal intervention to increase hand hygiene compliance of nurses in nursing homes through a cluster randomized controlled trial (HANDSOME study).
METHODS
Nursing homes were randomly allocated to 1 of 3 trial arms: receiving the intervention at a predetermined date, receiving the identical intervention after an infectious disease outbreak, or serving as a control arm. Hand hygiene was evaluated in nursing homes by direct observation at 4 timepoints. We documented compliance with the World Health Organization's 5 moments of hand hygiene, specifically before touching a patient, before a clean/aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. The primary outcome is hand hygiene compliance of the nurses to the standards of the World Health Organization. The secondary outcome is infectious disease incidence among residents. Infectious disease incidence was documented by a staff member at each nursing home unit. Outcomes will be compared with the presence of norovirus, rhinovirus, and Escherichia coli on surfaces in the nursing homes, as measured using quantitative polymerase chain reaction.
RESULTS
The study was funded in September 2015. Data collection started in October 2016 and was completed in October 2017. Data analysis will be completed in 2020.
CONCLUSIONS
HANDSOME studies the effectiveness of a hand hygiene intervention specifically for the nursing home environment. Nurses were taught the World Health Organization's 5 moments of hand hygiene guidelines using the slogan "Room In, Room Out, Before Clean, After Dirty," which was developed for nursing staff to better understand and remember the hygiene guidelines. HANDSOME should contribute to improved hand hygiene practice and a reduction in infectious disease rates and related mortality.
TRIAL REGISTRATION
Netherlands Trial Register (NTR6188) NL6049; https://www.trialregister.nl/trial/6049.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/17419.
背景
手部卫生依从性被认为是预防医疗保健相关感染最（具成本效益的）有效措施。虽然手部卫生干预措施在医院中经常实施和评估，但对于其他医疗保健环境中的手部卫生依从性以及哪些干预措施和实施方法有效，人们了解有限。
目的
本研究旨在通过一项整群随机对照试验（HANDSOME研究）评估多模式干预措施对提高养老院护士手部卫生依从性的效果。
方法
养老院被随机分配到3个试验组之一：在预定日期接受干预、在传染病爆发后接受相同干预或作为对照组。通过在4个时间点直接观察来评估养老院中的手部卫生情况。我们记录了对世界卫生组织手部卫生5个时刻的依从情况，具体为接触患者前、进行清洁/无菌操作前、有体液暴露风险后、接触患者后以及接触患者周围环境后。主要结局是护士对手部卫生依从性达到世界卫生组织标准的情况。次要结局是居民中的传染病发病率。每个养老院单元的工作人员记录传染病发病率。将通过定量聚合酶链反应测量养老院表面的诺如病毒、鼻病毒和大肠杆菌的存在情况，以此来比较结局。
结果
该研究于2015年9月获得资助。数据收集于2016年10月开始，并于2017年10月完成。数据分析将于2020年完成。
结论
HANDSOME研究专门针对养老院环境的手部卫生干预措施的有效性。使用“进房、出房、清洁前、脏污后”这一口号向护士传授世界卫生组织手部卫生5个时刻的指南，该口号是为护理人员更好地理解和记住卫生指南而制定的。HANDSOME应有助于改善手部卫生实践，并降低传染病发病率和相关死亡率。
试验注册
荷兰试验注册库（NTR6188）NL6049；https://www.trialregister.nl/trial/6049。
国际注册报告识别码（IRRID）：DERR1-10.2196/17419。
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